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Med Year 3 > Bowel Cancer and Acute Abdomen > Flashcards

Bowel Cancer and Acute Abdomen Flashcards

1
Q

what are some causes of fresh blood in stools?

A 
haemorrhoids 
acute anal fissures
colorectal neoplasms
acute proctitis 
IBD
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2
Q

what causes black stools or malaena?

A

bleeding from further up the GI tract, including small intestine or stomach

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3
Q

what are some risk factors for colorectal cancer?

A

family history
previous cancers
IBD
red meat and low fibres

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4
Q

where are the cancers most common?

A

2/3 in colon and rest in rectum
more left colon than right
recto-sigmoid colon most frequent site

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5
Q

what are the symptoms of bowel cancer?

A 
change in bowel habit
weight loss
PR bleeding
tenesmus 
IDA = TWO WEEK WAIT
bowel obstruction
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6
Q

when would you give a two week wait for CRC

A

> 6week change in bowel habit AND pr bleeding any age
change in BH >6 weeks and age >60
RB without any other symptoms and >60

palpable mass right sided or rectal any age
IDA any age

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7
Q

what investigations can you do for CRC

A

colonoscopy - first line and biopsy
barium enema
CT colonography (in patients less fit for colonoscopy)
CT TAP for metastasis in patients with weight loss

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8
Q

what is screening like in the UK for CRC?

A

Faecal immunochemical test: every 2 years to people age 60-74
faecal occult blood test

THEN colonoscopy

also - flexible cystoscopy

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9
Q

what is a polyp?

A

growth of tissue from a mucous membrane off a surface

benign or malignant, can become malignant
hyperplastic = completely benign

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10
Q

what is the dukes classification?

A

A - only mucosa and part of bowel wall - 90% prognosis
B - extending through muscle of bowel wall - 70-80%
C - lymph node involvement 50%
D - metastatic 5-10%

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11
Q

what other staging is used in CRC?

A

TNM staging - refer to notes

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12
Q

what are the treatment options for CRC?

A

surgical resection
chemotherapy
radiotherapy
palliation

polypectomy for prevention

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13
Q

what is FAP and how is it treated?

A

familial adenoma polyptosis - polyps in whole colon which will develop into cancer
total colectomy with ileo-anal pouch

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14
Q

what is the genetics of FAP

A

mutation in Apc gene - TSG

95% penetrance, CRC in 20-30s

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15
Q

what is hNPCC?

A

hereditary non-polyposis colon cancer
autosomal dominant
inherited mismatch repair genes

  • 70% penetrance, 30-50s age range, rapid progression and highly aggressive
  • use amsterdam criteria to exclude FAP
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16
Q

what are the types of surgical resection for CRC?

A

right hemicolectomy - tumours in caecam, ascending and proximal colon

left hemi-colectomy - tumours of distal transverse and descending colon

sigmoid colectomy - tumours of sigmoid colon

anterior resection - tumours of low SC or higher rectum

abdominoperineal resection - tumours of lower rectum; remove rectum and anus and suturing over, leaving them with permanent colostomy

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17
Q

what does a surgical resection involve?

A

removing a tumour and creating an end to end anastomosis

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18
Q

what is a covering loop ileostomy

A

temporary ileostomy to protect distal anastomosis
let it heal for 6-8 weeks tgeb reverse

loop: 2 ends of a section of small bowel being brought out onto skin (look for diagram)

lower right side of abdomen

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19
Q

what are complications of surgical resections for CRC?

A 
bleeding 
infection
pain
damage to nerves, ureter, bladder etc
anaesthetic risks 
anastomosis leak 
stoma?
failure
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20
Q

what are the follow ups for curative resections?

A

CT TAP at 1 and 2 and 3 years
Colonoscopy at 1 and 5 years
CEA every 6 months for 3 years

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21
Q

what is CEA?

A

carcinoembryonic antigen
tumour marker blood test for bowel cancer
useful to predict relapse of prev treated CRC

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22
Q

what is diverticular disease

A

outpouching of the colonic mucosa and submucosa through WEAKNESS in the outer muscle layers

  • commonest site is sigmoid colon due to pressure effects: chronic constipation and accumulation of faecal matter
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23
Q

what is diverticulosis?

A

presence of diverticula without symptoms
common as people age

no treatment

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24
Q

what is diverticulitis and what are the symptoms?

A

inflammation of the pouches/diverticula

  • left iliac fossa pain and tenderness
  • fever
  • diarrhoe
  • may have RB and mucus in stools
  • nausea and vomiting
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25
Q

how do you manage diverticulitis?

A 
admission if unwell or haemodynamically unstable
antibiotics 
analgesia 
fluid resuscitation
surgical resection ?
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26
Q

what are the complications of diverticular disease?

A

bleeding
infection —> diverticulitis
perforation; faeces leaking leading to peritonitis
abscess formation
FISTULA from colon to bladder: increase susceptibility to UTIs
obstruction

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27
Q

how do you explain diverticular disease to patients

A

wear and tear of the bowel

28
Q

what are the RF for diverticular disease

A 
high intake red meat
freq use of laxatives
chronic constipation and low fibre
hereditary factors
age
29
Q

what are the investigations you should do for diverticulitis?

A

FBC for infection and anaemia
U&E’s for CT contrast, electrolyte imbalance due to diarrhoea
CRP for inflammation
ABG for metabolic acidosis or alkalosis
lactate for sepsis in severe cases
blood cultures to rule out gastroenteritis

imaging: CT AP with contrast

30
Q

what is an acute abdomen?

A

condition of severe abdominal pain, usually requiring emergency surgery

caused by acute disease of or injury to internal organs

31
Q

what causes abdominal pain over the whole abdomen?

A

perforated viscous
acute pancreatitis
medical causes like DKA

32
Q

what causes RUQ pain?

A

biliary colic
acute cholecystitis
acute cholangitis

33
Q

what causes LUQ pain?

A

acute pancreatitis
spontaneous splenic rupture
medical disorders eg pneumonia

34
Q

what causes right iliac fossa pain?

A 
acute appendicitis
diverticulitis (less likely in right)
ectopic pregnancy 
ovarian cyst
crohn's
35
Q

what causes epigastric pain?

A

pancreatitis
peptic ulcer disease
AAA

36
Q

what causes central umbilical pain?

A 
AAA
early appendicitis
intestinal obstruction
ischaemic colitis
mesenteric thrombosis - in elderly
37
Q

what causes left iliac fossa pain?

A

diverticulitis
constipation
ectopic pregnancy
ovarian cyst

38
Q

what causes suprapubic pain?

A

acute urinary retention
pelvic inflammatory disease
UTI
ectopic pregnancy

39
Q

what causes loin to groin pain?

A

renal colic
AAA
pyelonephritis

40
Q

what are some classical signs of acute abdomen?

A 
fever low grade
tenderness
rigidity and guarding
rebound tenderness
bowel sounds:
  - absent in peritonitis
  - increased in small bowel obstruction

abdo distension

41
Q

what investigations would you do for an acute abdomen?

A 
FBC
U&E for CT contrast
LFTs
CRP
amylase
INR: synthetic function of liver, coagulation before theatre
ABG: PO2 and calcium for acute pancreatitis 
lactate: tissue ischaemia 
abdo xray for bowel obstruction 
erect CXR for bubble under diaphragm 
USS abdo: gall stones, biliary duct dilatation and gynae
CT
42
Q

how do you manage an acute abdomen?

A 
ABCDE
nil by mouth 
IV access
IV fluids
analgesia and anti-emetics
NG tube if vomiting and suspected obstruction
catheterise for fluid balance monitoring
escalate care
43
Q

what is peritonitis

A

inflammation of peritoneum
localised: cause: underlying organ inflammation
generaliseD: perforation of abdo organ eg ulcer/appendix

spontaneous bacterial: infection of ascites in cirrhotic liver disease

44
Q

what are some other symptoms of peritonitis and how do you treat it?

A

guarding
rebound tenderness
minimal bowel sounds

  • laparotomy
45
Q

what is a hernia?

A

structure that passes through space or defect into an abnormal location

46
Q

how do you describe a hernia?

A

reducible
irreducible
obstructed (bowel lumen is no longer open)
strangulated - compression around hernia preventing BF to bowel lumen

47
Q

how does a hernia present?

A

painless swelling
may be asymptomatic
or pain when coughing, change in bowel habits, constipation, scrotal swelling

48
Q

what is an inguinal hernia, how is it caused and treated?

A

protrusion of abdominal contents emerging through superficial ring as an exit

caused by weakening of muscles/increased intra-abdominal pressure so eg chronic cough, constipation, heavy lifting

treated via open or laparoscopic
reduce hernial contents back into cavity and put mesh that strengthens wall

49
Q

what is a femoral hernia

A

just below inguinal ligament, abdo contents pass through weakening in femoral canal
higher risk of strangulation

50
Q

what are the other types of hernias?

A
  • umbilical

- incisional: near or on surgical site

51
Q

what is a hiatus hernia

A

herniation of stomach through opening in diaphragm (LES)
herniation causes contents to reflux up oesophagus and give reflux symptoms

treatment: medical management of symptoms or surgical

52
Q

what are direct inguinal hernias

A

pierces posterior wall, doesn’t go through deep ring and then exits through superficial

53
Q

what are indirect inguinal hernias?

A

does not pierce posterior wall, passes through deep inguinal ring then into inguinal canal and exits superficial ring

54
Q

how do you tell on examination the difference between indirect and direct

A

put finger over deep inguinal ring = can control indirect but not direct

55
Q

what is bowel obstruction

A

mechanical blockage of intestinal contents

= gross dilatation of proximal bowel

secretions of large volumes of electrolyte rich fluid into bowel

56
Q

what are the types of bowel obstruction?

A

functional or paralytic ileus = when bowel not mechanically blocked but inflammation / electrolyte imbalance/ surgery means not working properly

closed loop: second obstruction proximally
sugrical emergency

57
Q

what causes bowel obstruction?

A

small bowel - adhesions and hernia
large - malignancy and diverticular disease

intraluminal: gallstone ileus, ingested foreign body
mural: obstruction from bowel wall eg cancer, strictures, DD
extramural: outside of bowel causing obstruction by narrowing lumen eg hernia

58
Q

what are the cardinal features of BO?

A 
Abdominal pain colicky
vomiting
abdo distension
absolute constipation (Early in distal and late in proximal obst)
59
Q

what are the clinical features of BO?

A

guarding and rebound tenderness - NONE

tympanic sound or tinkling bowel sounds on percussion and auscultation

60
Q

what are the differentials for obstructed bowel disease?

A

toxic megacolon

constipation

61
Q

how do you test for BO?

A

bloods for electryolytes and third space losses
venous blood gas bc evaluate signs of ischaemia

CT contrast AP
AXR
erect CXR to assess for free air under diaphragm

62
Q

what is small bowel obstruction

A

dilated bowel >3cm
central
valvulae conniventes visible

63
Q

what is large bowel obstruction?

A

dilated bowel >6cm
peripheral location
haustral lines visible

64
Q

how do you treat BO?

A

fluid resusc
catheter
surgical if necessary

conservative: drip and suck = nil by mouth, insert NG tube
IV fluids and correct electrolytes

65
Q

what is the surgical intervention for BO?

A

resection

66
Q

what are the complications of bowel obstruction

A

bowel ischaemia
bowel perforation
dehydration and renal impariment

Med Year 3 (25 decks)

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